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SUMMARY: The study will provide information on the morphometrics of the vertebrae, which can be used to guide clinicians on the appropriate size of transpedicular screws to use in spine interventions among the Jordanian population and for comparative studies with other races. A retrospective analysis of normal CT scans of the lumbar and thoracolumbar areas was done. Linear and angular measurements of 336 vertebrae were collected for 25 males and 23 females. The results were compared between right and left and between both sexes. The L5 has the longest AVBH and the shortest PVBH in both sexes, it also, had the shortest and widest pedicle in both males and females. ratio of the AVBH to PVBH showed progressive increase in both sexes from T11 to L5. Similarly, the VBW increased progressively from the top to the bottom in both sexes, but it was significantly different between both sexes. The L1 was the most cranially oriented vertebrae in males while the L2 showed the most cranial orientation in females. Both sexes L5 was the most caudally oriented vertebrae. This study provides a database for vertebral morphometrics in the Jordanian population, there are slight differences between the right and left side in the upper studied vertebrae (T11-L2) and some measurement showed significant differences between males and females. These findings need to be taken into consideration when inserting pedicle screws.
Este estudio proporciona información sobre la morfometría de las vértebras, la cual puede ser utilizada por los médicos oara determinar el tamaño adecuado de los tornillos transpediculares a utilizar en intervenciones de columna en la población jordana y para estudios comparativos con otras grupos. Se realizó un análisis retrospectivo de tomografías computarizadas normales de las áreas lumbar y toracolumbar. Se recogieron medidas lineales y angulares de 336 vértebras de 25 hombres y 23 mujeres. Los resultados se compararon entre vértebras derechas e izquierdas y entre ambos sexos. La L5 tiene el AVBH más largo y el PVBH más corto en ambos sexos, también tenía el pedículo más corto y más ancho tanto en hombres como en mujeres. La relación de AVBH a PVBH mostró un aumento progresivo en ambos sexos de T11 a L5. De manera similar, el VBW aumentó progresivamente de arriba hacia abajo en ambos sexos, pero fue significativamente diferente entre ambos sexos. La L1 fue la vértebra más orientada cranealmente en los hombres, mientras que la L2 mostró la orientación más craneal en las mujeres. En ambos sexos L5 fue la vértebra más orientada caudalmente. Este estudio proporciona una base de datos para la morfometría vertebral en la población jordana, donde existen ligeras diferencias entre el lado derecho e izquierdo en las vértebras superiores estudiadas (T11-L2). Algunas mediciones mostraron diferencias significativas entre hombres y mujeres. Estos hallazgos deben tenerse en cuenta al insertar tornillos pediculares.
Subject(s)
Humans , Male , Female , Lumbar Vertebrae/diagnostic imaging , Tomography, X-Ray Computed , Retrospective Studies , Jordan , Lumbar Vertebrae/anatomy & histologyABSTRACT
Introduction:The lumbar vertebrae are affected in conditions such as congenital defects, degenerative diseases, accidents, and cancer metastasis. A thorough knowledge of the morphometry of typical and atypical lumbar vertebrae in adults of South Indian population is needed for lumbar spine surgeries. MaterialsandMethods: Adescriptive study was done on 200 dry lumbar vertebrae, of which 100 were typical and 100 were atypical lumbar vertebrae. The following dimensions of both typical and atypical lumbar vertebrae were measured with digital vernier calipers: anteroposterior and transverse diameters of the body; anterior and posterior body heights; anteroposterior and transverse diameters of vertebral foramen; height, breadth, and width of the laminae; length, height, and width of the pedicles; transverse processes and spinous process; distance between the two superior articular processes; and the distance between the two inferior articular processes. All the measurements were tabulated. The mean and standard deviation were calculated for each of the parameters and the results were statistically analyzed. Results: The anteroposterior and transverse diameters of the body, the height of the laminae on both sides, the length and height of the spinous process, and the distance between the superior articular facets were significantly longer in atypical lumbar vertebrae than that of typical lumbar vertebrae (P < 0.05). There was no significant difference in measurements between both sides. Conclusion: The dimensions of vertebral foramen, transverse processes, spinous processes, and distance between articular processes were different from the dimensions of previous studies. The morphometric data obtained will be useful for orthopedic procedures on the lumbar vertebrae in South Indian population
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Abstract Lumbar facet syndrome stands out as a significant cause for the increasing prevalence of back pain complaints. Alternatives such as radiofrequency (RF) ablation may be a therapeutic option to relieve the chronic pain associated with this condition. It is critical to analyze the effectiveness of lumbar facet syndrome treatment using the traditional RF ablation technique and the relief generated by it in chronic low back pain (CLBP). This study is a systematic review using the following inclusion criteria: title, observational studies, clinical trials, controlled clinical trials, clinical studies, and publications over the last 17 years (from 2005 to 2022). The exclusion criteria included papers addressing other themes and review articles. The databases used for data collection included the Medical Literature Analysis and Retrieval System Online (Medline), PubMed, Scientific Electronic Library Online (SciELO), Lilacs, and Biblioteca Virtual em Saúde (Virtual Health Library in Portuguese). The query used the following terms: facet, pain, lumbar, and radiofrequency. The application of these filters yielded 142 studies, and 12 were included in this review. Most studies indicated that the traditional RF ablation technique was beneficial in relieving CLBP refractory to conservative treatment.
Resumo Em um contexto de aumento da prevalência de queixas de dores na coluna, a síndrome facetária se destaca como um importante causador. Alternativas como a ablação por radiofrequência (RF) podem ser uma opção de terapia para alívio da dor crônica que essa patologia pode causar. É necessário analisar a eficácia do tratamento da síndrome facetária pela técnica de ablação por radiofrequência tradicional e o alívio gerado nas dores lombares crônicas (DLC). O presente estudo trata-se de uma revisão sistemática cujo os critérios de inclusão para análise foram: título; estudos observacionais; ensaios clínicos; ensaio clínico controlado; estudos clínicos e publicação nos últimos dezessete anos (2005-2022). Já os critérios de exclusão foram: artigos que abordavam outras temáticas e artigos de revisão. As bases utilizadas para coleta de dados incluíram Medical Literature Analysis and Retrieval System online (Medline), Pubmed, Scientific Electronic Library Online (SciELO), Lilacs, Biblioteca Virtual em Saúde. Os termos utilizados para a pesquisa foram: facet; pain; lumbar; radiofrequency. Aplicando-se os filtros foram encontrados 142 estudos, 12 foram incluídos. Os estudos em sua maioria apontaram ser benéfica a técnica de ablação por radiofrequência tradicional no alívio das dores lombares crônicas refratárias ao tratamento conservador.
Subject(s)
Humans , Low Back Pain/therapy , Zygapophyseal Joint , Radiofrequency Therapy , Lumbar VertebraeABSTRACT
INTRODUCTION: Neurogenic claudication (NC) is the classic clinical presentation of patients with Lumbar Spinal Stenosis (LSS). These patients may or may not present with symptoms of leg pain and difficulty walking. These symptoms are exacerbated while walking and standing and are eased by sitting or bending forward. METHOD: Patients with LSS, having a lumbar canal diameter of ≤12mm, were recruited from a recognized Tertiary care hospital. Each subject's demographic characteristics and anthropometrics were noted, and the testing procedure was explained. The canal diameter was documented with the help of an MRI report. A self-paced walking test was used to assess the walking distance. STATISTICAL ANALYSIS: Depending on the normality of the data, the Pearson correlation coefficient (r) was used to find the correlation between canal diameter at different lumbar levels and walking distance in patients with LSS. RESULT: Pearson correlation coefficient (r) determined a fair positive correlation (r = 0.29) between lumbar canal diameter and walking distance. Stepwise multiple regression analysis was done, and a prediction equation was found for different levels of canal stenosis. CONCLUSION: Findings of our present study suggest a fair positive correlation between walking distance and canal diameter at L5-S1. This study may also be useful in predicting the approximate canal diameter by estimating the walking distance of the patient with symptoms of LSS and vice-versa.
INTRODUÇÃO: A claudicação neurogênica (CN) é a apresentação clínica clássica de pacientes com Estenose Espinhal Lombar (EEL). Esses pacientes podem ou não apresentar sintomas de dor nas pernas e dificuldade para caminhar. Esses sintomas são exacerbados ao caminhar e ficar em pé e são aliviados ao sentar ou inclinar-se para a frente. MÉTODO: Pacientes com EEL, com diâmetro do canal lombar ≤12mm, foram recrutados em um hospital terciário reconhecido. As características demográficas e antropométricas de cada sujeito foram anotadas e o procedimento do teste foi explicado. O diâmetro do canal foi documentado com a ajuda de um relatório de ressonância magnética. Um teste de caminhada individualizado foi usado para avaliar a distância percorrida. ANÁLISE ESTATÍSTICA: Dependendo da normalidade dos dados, o coeficiente de correlação de Pearson (r) foi usado para encontrar a correlação entre o diâmetro do canal em diferentes níveis lombares e a distância percorrida em pacientes com EEL. RESULTADO: O coeficiente de correlação de Pearson (r) determinou uma correlação positiva razoável (r = 0,29) entre o diâmetro do canal lombar e a distância percorrida. Análise de regressão múltipla stepwise foi feita, e uma equação de predição foi encontrada para diferentes níveis de estenose do canal. CONCLUSÃO: Os achados de nosso estudo sugerem uma correlação positiva razoável entre a distância percorrida e o diâmetro do canal em L5-S1. Este estudo também pode ser útil para prever o diâmetro aproximado do canal, estimando a distância percorrida pelo paciente com sintomas de EEL e vice-versa.
Subject(s)
Pilot Projects , Patients , Spinal StenosisABSTRACT
Objective: To investigate the analgesic mechanism of Tuina (Chinese therapeutic massage) by observing the effect of the N-methyl-D-aspartate receptor subunit 2B (NR2B)/postsynaptic density-95 (PSD-95) pathway on the dendritic structure of spinal cord dorsal horn in rats with lumbar disc herniation. Methods: Fifty Sprague-Dawley rats were randomly divided into a blank group, a model group, a Tuina group, a blocker agent group, and a blocker agent + Tuina group. The sciatic nerve chronic constriction injury (CCI) model was prepared by the sciatic nerve ligation method. From the 4th day after modeling, rats in the Tuina group and the blocker agent + Tuina group were subject to daily Tuina intervention, and those in the blocker agent group and the blocker agent + Tuina group were daily intrathecally injected with NR2B blocker agent (MK-801). The spontaneous pain score was used to observe the pain behavior of all rats. The expression levels of NR2B and downstream PSD-95 were measured by immunohistochemistry, and the dendritic structure changes were observed by Golgi staining for rat spinal cord dorsal horn after 14 d of continuous intervention. Results: Compared with the blank group, the degree of rat spontaneous pain after CCI was elevated in both the model and the Tuina groups (P<0.01) and was reduced in the Tuina group after the Tuina intervention compared with the model group (P<0.05). Compared with the model group, the rat spontaneous pain level after blocking NR2B was reduced in both the blocker agent group and the blocker agent + Tuina group (P<0.05). The NR2B and PSD-95 protein levels were significantly higher in the model group compared with the blank group (P<0.01); the total number of dendritic branches was increased (P<0.01), and the total dendritic length became longer (P<0.01) in the spinal cord dorsal horn. The rat NR2B and PSD-95 protein levels were significantly decreased in the Tuina group compared with the model group (P<0.01); the total dendritic branch number was reduced (P<0.01) and the total length was shortened (P<0.01) in the spinal cord dorsal horn. After blocking NR2B, the expression levels of NR2B and downstream PSD-95 protein were significantly lower in both the blocker agent group and the blocker agent + Tuina group compared to the model group (P<0.01). The total branch number was significantly reduced (P<0.01), and the total length was significantly shortened (P<0.01) of the dendrites in the spinal cord dorsal horn. Conclusion: Tuina may exert an analgesic effect by remodeling the dendritic structure in the spinal cord dorsal horn in rats with lumbar disc herniation, and its mechanism may be related to the inhibition of NR2B/PSD-95 signaling pathway.
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Objective: To evaluate the effects of Liu Zi Jue Qigong (LQG)-based breathing training on the curvature and range of motion (ROM) of the thoracic and lumbar spines in different positions. Methods: Forty-seven college students were selected as subjects and randomly divided into an observation group and a control group. In the observation group, 27 subjects received regular LQG-based breathing training for 12 weeks, while 20 subjects in the control group did not receive any intervention. The spine measuring instrument Spinal Mouse was adopted to detect the curvature and ROM of the thoracic and lumbar spines. Results: In the observation group, the changes in the curvatures of thoracic spine in the upright and forward-bending positions showed statistical significance after LQG exercise (P<0.05), while there was no notable difference in the control group. The comparison of ROM of the thoracic spine from the upright position to the forward-bending and load-bearing positions showed statistically significant difference in the observation group (P<0.05), while there was no significant difference in the control group. There was no significant difference in the lumbar curvature and ROM in the two groups after LQG exercise. Conclusion: LQG-based breathing training improves the curvature and ROM of the thoracic spine.
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Objective:To compare the efficacy of reduction and in situ intervertebral fusion fixation in the treatment of degenerative lumbar spondylolisthesis.Methods:A total of 182 patients (92 males and 90 females) with L 4 degenerative lumbar spondylolisthesis of Meyerding's classification of grade I and grade II, aged (62.6±6.8) years (range, 57-73 years), who underwent posterior L 4, 5 internal fixation and interbody fusion in the Department of Spinal Surgery, the Second Hospital of Shanxi Medical University, were retrospectively analyzed from January 2019 to December 2022. There were 105 cases of I-degree spondylolisthesis and 77 cases of II-degree spondylolisthesis. According to the operation method, the patients were divided into reduction intervertebral fusion fixation (reduction group) and in situ intervertebral fusion fixation group (in situ group). Imaging parameters such as lumber lordosis (LL), pelvic incidence (PI)-LL, L 3, 4 intervertebral space heights, fusion segment angle, and sagittal vertical axis (SVA) were measured on the pre- and post-surgical lumbar spine lateral radiographs. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) of low back pain were recorded before and after surgery. The differences in clinical and imaging parameters were compared between reduction and in situ fusion group. Results:All 182 patients successfully completed the surgery and were followed up for 12.0±2.4 months (range, 9-15 months). The LL of the reduction group before surgery, immediately after surgery, and at the last follow-up were 46.9°±7.1°, 57.2°±5.9°, 55.6°±5.5°, respectively, with statistically significant differences ( F=87.61, P<0.001), with immediate and final follow-up being smaller than those in the in situ fixation group. The LL of the in situ fixation group before surgery, immediately after surgery, and at the last follow-up were 47.8°±7.2°, 50.5°±7.0°, and 48.7°± 6.4°, respectively, with no statistically significant difference ( F=2.83, P=0.062). The immediate and final follow-up of LL in the reduction group was lower than those in the in situ fixation group ( P<0.05). The fusion segment angles of the reduction group before surgery, immediately after surgery, and at the last follow-up were 14.2°±5.1°, 23.2°±4.7°, 23.2°±4.7°, respectively, with statistically significant differences ( F=152.87, P<0.001), with immediate and final follow-up after surgery being greater than before surgery. The fusion segment angles of the in situ fixation group before surgery, immediately after surgery, and at the last follow-up were 15.4°±5.9°, 18.2°±5.5°, and 17.4°±5.1°, respectively, with statistically significant differences ( F=4.69, P=0.009), with immediate and final follow-up being greater than before surgery. The fusion segment angulation in the reduction group was greater than that in the in situ fixation group at both the immediate and final follow-up ( P<0.05). The SVA of the reduction group before surgery, immediately after surgery, and at the last follow-up were 16.9±18.2 mm, 9.5±12.0 mm, and 8.7±11.3 mm, respectively, with statistically significant differences ( F=11.32, P<0.001), with immediate and final follow-up being smaller than before surgery. The SVA of immediately after surgery and at the last follow-up were both smaller than before surgery. The SVA of the in situ fixation group before surgery, immediately after surgery, and at the last follow-up were 16.4±17.2 mm, 14.3±15.5 mm, and 13.8±15.0 mm, respectively, with no statistically significant difference ( F=0.57, P=0.576). The SVA of the reduction group at immediate and final follow-up was lower than that of the in situ fixation group ( P<0.05). Conclusion:Both reduction and in situ intervertebral fusion fixation can effectively relieve the clinical symptoms of patients. Fusion fixation after reduction can improve the angulation of fusion segments to form segmental kyphosis, which is more conducive to improving SVA.
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Low back pain (LBP) is a common clinical condition, and non-specific LBP is believed to be associated with lumbar instability caused by paraspinal muscle (PSM) degeneration. Therefore, MRI evaluation of PSM degeneration can help predict the progression of low back pain-related diseases. At present, the most commonly used MRI parameters are the cross-sectional area (CSA) and fat infiltration (FI) of PSM. In order to assess the degree of PSM degeneration more accurately, modified parameters including functional CSA, relative CSA and muscle-fat infiltration index (MFI), have been designed. Advancements in MRI technology,such as the application of IDEAL-IQ, allow for early detection of changes in fat infiltration. Additionally, the proton density fat fraction (PDFF) derived from chemical shift encoding based water-fat MRI (CSE-MRI), also shows promise in studying PSM. Numerous MRI studies, both domestically and internationally, have aimed to establish the relationship between PSM degeneration and non-specific LBP, lumbar degenerative diseases, degenerative lumbar scoliosis, and osteoporosis. It has been found that PSM degeneration is affected by other factors such as intervertebral disc, articular process and endplate degeneration. Furthermore, PSM degeneration and scoliosis/kyphosis are also reciprocal causation. Higher fat content in the vertebral body and PSM is associated with increased bone fragility, while vertebroplasty following osteoporotic vertebral fracture can delay PSM degeneration and improve quality of life.
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Objective:To investigate the clinical outcomes of minimally invasive lateral lumbar interbody fusion (LLIF) and the necessity to perform LLIF plus posterior direct decompression in the treatment of severe degenerative lumbar spinal stenosis (DLSS).Methods:In this prospective randomized, controlled trial, we assigned 71 patients, who were 50 to 80 years old, and diagnosed with severe DLSS (Schizas Classification grade C on magnetic resonance imaging), in a 1∶1 ratio to undergo either one-stage LLIF plus posterior internal fixation (treatment group) or CLIF plus posterior internal fixation with laminectomy (control group). Demographic and perioperative data were collected and compared. The clinical outcome measures included Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) score as well as visual analogue scale (VAS). Patients were followed up for at least 1 year.Results:The treatment group included 36 patients with 46 surgical levels, while the control group included 35 patients with 46 surgical levels. The baseline demographic data of the 2 groups were equivalent in preoperative central canal areas, spinal canal anteroposterior diameter, disc height, ODI, ZCQ score for symptom severity and physical function, as well as VAS scores for back and leg pain. The mean operative time, blood loss, drainage volume and hospital stay of the treatment group are significantly less than the control group (157.2±29.1 min vs. 180.6±26.8 min, 75.6±39.1 ml vs. 108.6±43.3 ml, 136.9±73.9 ml vs. 220.5±121.3 ml, 5.3±1.1 d vs. 6.6±2.3 d). There were 2 cases with dura tear and 1 case with wound infection in control group. Thus, the surgical trauma and complications of the control group were more than the treatment group. At 1-year follow-up, the mean ODI score of treatment group improved from 42.24%±10.70% preoperatively to 18.21%±11.49%, the mean ZCQ symptom severity from 2.89±0.38 to 1.61±0.41, the mean ZCQ physical function from 2.31±0.45 to 1.50±0.37, the mean VAS for back from 5.56±1.19 to 1.97±1.13 and the mean VAS for leg from 4.44±1.81 to 0.94±1.26. At 1-year follow-up, the mean ODI score of the control group improved from 43.65%±14.93% preoperatively to 17.36%±12.15%, the mean ZCQ symptom severity from 2.92±0.52 to 1.65±0.39, the mean ZCQ physical function from 2.37±0.52 to 1.55±0.39, the mean VAS for back from 5.63±1.40 to 2.34±1.47, and the mean VAS for leg from 4.37±2.14 to 0.83±1.20. The ZCQ satisfactory score of both groups were not significant different (1.25±0.45 vs. 1.26±0.43, t=0.07, P=0.944). The mean improvement rate of both groups for ODI, ZCQ symptom severity, ZCQ physical function, VAS back and VAS leg at 1-year follow-up were not significant different (55.43%±27.74% vs. 58.36%±25.06%, 43.07%±17.22% vs. 42.66%±12.95%, 32.25%±23.65% vs. 31.71%±23.24%, 62.65%±21.25% vs. 58.37%±22.44%, 78.94%±26.41% vs. 85.45%±20.53%). One adjacent segment disease was found in each group at 1 year follow-up. Conclusion:CLIF+ posterior internal fixation in the treatment of Schizas Grade C DLSS has satisfactory clinical outcome at 1-year follow-up. Laminectomy increases surgical trauma, but does not significantly improve the clinical outcome at 1-year follow-up.
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Objective:To explore the application value of graded surgical strategy and balanced load concept for thoracolumbar osteoporotic compression fractures (OVCFs) with kyphosis.Methods:All of 56 patients of thoracolumbar OVCFs with kyphosis were studied, including 11 males and 45 females, with an average of 75.6±9.3 years old. All patients had back pain, and 32 patients had nerve compression, including 5 patients with aggravation of vertebral collapse after conservative treatment, and 1 patient with cement loosening after percutaneous kyphoplasty (PKP) in another hospital. A graded surgical strategy was developed according to the concept of balanced load, including whether there existed nerve compression, kyphosis, sagittal index (SI), vertebral collapse, load capacity of anterior and middle columns, and fracture reducibility. All patients were treated with anti osteoporosis therapy. 24 patients without nerve compression underwent posture reduction and PKP; 32 patients with nerve compression underwent open surgery: 5 patients with arcuate ky-phosis and SI≤15° underwent Ponte osteotomy; 15 patients with angular kyphosis or SI>15° underwent posterior pedicle subtraction osteotomy (PSO) or/and modified PSO including intervertebral space; 11 patients with SI>15° and severe vertebral collapse (the height of anterior and middle vertebral bodies <1/3 of the average height of adjacent vertebral bodies) or cement loosen after PKP underwent vertebrectomy and reconstruction, of which 4 patients underwent posterior vertebral column resection (PVCR), and 8 patients underwent combined surgery including anterior subtotal vertebrectomy with support and posterior pedicle fixation. The clinical efficacy was evaluated by pain visual analog score (VAS) and Oswestry dysfunction index (ODI).Results:All patients were followed up for 12-60 months, with an average of 24.2 months. For the 24 patients with PKP, the symptoms improved significantly, and 1 case had adjacent vertebral fracture that was improved after PKP again. For the 32 patients with open surgery, the intraoperative blood loss was 400-1 800 ml, with an average of 960 ml (PVCR > PSO and combined surgery > Ponte); the operation time was 2-7 h, with an average of 4.3±1.9 h. The neurological symptoms improved after the operation. During follow-up, the artificial vertebral body and titanium mesh collapsed in 3 cases, but did not continue to deteriorate, no vertebral fracture, internal fixation displacement or loosening failure occurred on X-ray films. At the last follow-up, the VAS score and ODI score of 56 patients decreased from 7.0±2.6 and 60.4±16.2 pre-operation to 1.4±1.1 and 9.5+5.8 respectively, and local kyphosis angle improved from 18.1±4.3 pre-operation to 5.6±4.3. According to the overall satisfaction of patients, the effect was fair in 12 cases, good in 30 cases, excellent in 14 cases, and the excellent and good rate was 78.6%.Conclusion:The graded surgical strategy for thoracolumbar OVCFs with kyphosis based on the concept of balanced load can restore the balanced load of the anterior and middle columns of the spine, reduce the fixation and fusion segments, and reduce the risk of internal fixation displacement and loosening failure.
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Objective:To investigate the efficacy of oblique lumbar interbody fusion (OLIF) combined with percutaneous transforaminal endoscopic decompression (PTED) and posterior pedicle fixation through Wiltse approach in the treatment of lumbar spondylolisthesis accompanied with lumbar spinal stenosis.Methods:From June 2017 to February 2022, 103 patients (50 males and 53 females) of lumbar spondylolisthesis accompanied with lumbar spinal stenosis were performed with OLIF combined with PTED and posterior pedicle fixation. The mean age was 64.1±5.2 years (range, 42-87 years). All involved cases were single-segment and included 83 cases of L 4, 5, 17 cases of L 3, 4, and 3 cases of L 2, 3. Among them, 94 cases were performed for the first time, and other 9 were revision surgery treated by posterior lumbar laminectomy previously. The visual analog scale (VAS) was used to evaluate the low back pain and leg pain, and the Oswestry disability index (ODI) was used to evaluate the lumbar function. The VAS and ODI scores were recorded respectively before the operation, at discharge, 1, 3, 6 months after the operation and at the last follow-up. Macnab criteria was used to evaluate the clinical efficacy at the last follow-up. At the same time, imaging measurements were conducted, including the anterior and posterior disc height, segmental lordotic angle, percentage of slip on lateral X-ray film and the vertebral canal area on axial MRI before and after surgery. Results:All of 103 patients were successfully operated in one stage with an average operation time of 177.7±21.5 min (range, 155-220 min), and an average intraoperative blood loss of 55.9±18.3 ml (range, 30-150 ml). The mean follow-up time were 15.1±2.6 months (range, 6-36 months). There were significant differences in both VAS scores of back and leg and ODI scores at each postoperative time point when compared with preoperative ( F=508.25, F=1524.82, F=1148.68, P<0.001). Macnab criteria of the last follow-up was evaluated as follow: excellent in 85 cases, good in 14, fair in 4, and the excellent and good rate was 96.1%. The radiographic results showed the mean immediate postoperative anterior disc height, posterior disc height, segmental lordotic angle, percentage of slip and axial area of the vertebral canal were 15.23±2.97 mm, 9.32±2.31 mm, 14.36°±4.18°, 3.89%±3.11%, 113.37±47.27 mm 2, and thus all of those increased significantly compared to the mean preoperative 11.93±3.17 mm, 7.21±2.03 mm, 6.15°±3.99°, 23.66%±7.79%, 57.63±28.91 mm 2, respectively ( t=7.84, t=7.07, t=14.91, t=27.62, t=9.68, P<0.001). All cases achieved bony fusion during 6-12 months after operation. The incidence of surgery-related complications was 10.7% (11/103). There were 3 cases of end plate fracture and 2 cases of dural injury, which had no complaint after operation. There was 1 case of pedicle screw entering into the spinal canal by mistake, and the symptoms of nerve damage appeared after operation. After 1 year it basically returned to normal. There were 2 cases of thigh numbness and 1 case of psoas major weakness after operation, all of which relieved after 4 weeks. There was 1 case continuous pain of abdominal incision after surgery. There was 1 case of cage subsidence at the last follow-up. Conclusion:OLIF combined with PTED and posterior pedicle fixation through Wiltse approach is a minimally invasive surgical method for the treatment of lumbar spondylolisthesis accompanied with lumbar spinal stenosis. With the combined minimally invasive techniques, the decompression, fusion and fixation of the lumbar spine can be fulfilled perfectly. It has the advantages of minimally invasive, good clical outcome, few complications and rapid rehabilitation.
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Objective:To observe the morphological characteristics of L 4, 5 facet joints in patients with degenerative lumbar spondylolisthesis (DLS) of different spinopelvic types based on Roussouly classification. Methods:We retrospectively analyzed 142 patients with DLS who visited the department of orthopaedics in the Affiliated Hospital of Southwest Medical University from August 2018 to May 2022. There were 33 males aged 65.0±10.7 years and 109 females aged 61.8±9.6 years. The following morphological parameters of the L 4, 5 facet joint were measured on the CT images: facet joint angle (FJA), pedicle facet angle (PFA), facet joint tropism (FT) and facet joint osteoarthritis (OA) degree; the sacral slope (SS), lumbar lordosis (LL) and percentage of L 4 slip distance (SDP) were measured on preoperative standing neutral lumbar radiographs. According to the Roussouly classification, the patients were divided into four groups (type I, type II, type III, and type IV). The differences of morphological parameters of the facet joints and SDP were compared among the four groups, and the correlation between the FJA and PFA was analyzed. Results:There were 142 patients, including 28 type I, 50 type II, 43 type III, and 21 type IV according to the Roussouly classification. The SDPs of type I, type II, type III, and type IV were 19.1%±3.4%, 18.6%±3.9%, 21.7%±3.9%, 25.0%±2.4%, respectively. Except for types I and II, there were statistically significant differences in pairwise comparison among all other types ( P<0.05). The FJAs in type I and type II (31.4°±6.3°, 35.2°±6.8°) were larger than those in type III (28.4°±5.6°) and type IV (23.4°±4.5°), and the FJA in type III was larger than that in type IV. Conversely, the FJA in type I was smaller than that in type II. These differences were statistically significant ( P<0.05). The PFAs in type I and type II (113.9°±4.9°, 111.3°±5.6°) were smaller than those in type III (116.3°±4.4°) and type IV (121.8°±3.5°), and the PFA in type III was smaller than that in type IV, while, the PFA in type I was larger than that in type II. These differences were statistically significant ( P<0.05). The degree of OA in both type I and type II was lower than that in type III and type IV, with statistically significant differences ( P<0.05). However, there were no statistically significant differences in the degree of OA between type I and type II and between type III and type IV ( P> 0.05). Additionally, there were no statistically significant differences ( F=0.40, P=0.752) in the FT values among type I, type II, type III, and type IV (5.8°±2.3°, 5.6°±2.4°, 6.1°±1.8°, 5.9°±1.9°). Pearson correlation analysis showed that FJA was negatively correlated with PFA ( r=-0.68, P<0.001). Conclusion:In the slip segment of DLS, the facet joint morphology was part of the joint configuration in different spinopelvic types, not just the result of joint remodeling after DLS. Morphological characteristics of the facet joints and DLS interacted with each other.
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Objective:To systematically evaluate whether the early use of bracing after posterior lumbar fusion has advantages in terms of the improvement of clinical outcomes such as pain, functional disability, fusion rate, and complication rate in patients with lumbar degenerative diseases.Methods:All randomized controlled trials of bracing performed after posterior lumbar fusion in patients with lumbar degenerative diseases were searched in Pubmed, Web of Science, Embase, China national knowledge infrastructure (CNKI) and Wanfang database from January 1990 to May 2022. The data extracted were authors, year of publication, nationality, subject characteristics, sample size, surgical protocol, type and time of bracing, follow-up duration, preoperative and postoperative Oswestry disability index (ODI) and visual analogue scale (VAS), postoperative fusion rate and complication rate. The Cochrane Risk of Bias tool was used to evaluate the risk of bias. The use of fix- or random-effect models was depended on the magnitude of heterogeneity. Data analysis was performed using Stata 17.0 statistical software for meta analysis.Results:A total of five randomized controlled trials were included, all in English, with a total of 362 patients (male 144, female 218). The results of meta-analysis showed that there was no statistically significant difference in the improvement of ODI scores [ MD=1.25, 95% CI(-2.39, 4.88), P=0.501]and VAS scores[ MD=0.21, 95% CI(-0.22, 0.63), P=0.340]between the brace group and the control group after operation. In terms of fusion rate, there was no significant difference between the brace group and the control group[ OR=0.59, 95% CI(0.25, 1.38), P=0.224]. In addition, there was also no significant difference in the incidence of postoperative complications between two groups[ OR=1.12, 95% CI(0.58, 2.15), P=0.735]. Conclusion:The early use of bracing after lumbar fusion has no significant advantages in improving symptoms and functional recovery, fusion rate and surgical complications. The necessity of postoperative bracing after posterior lumbar fusion requires further high-quality research to prove.
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Objective:To investigate the effect of unilateral biportal endoscopy (UBE) through extraforaminal approach in the treatment of extra canal lumbosacral nerve entrapment.Methods:Seventeen patients with extra canal lumbosacral nerve root entrapment were treated by UBE through extraforaminal approach in Tianjin Hospital from January 2020 to March 2022, including 9 males and 8 females with an average age of 59.2 years (range 45-71 years). All 17 patients had lower limb radiation pain, numbness, and weakness with or without intermittent claudication. MRI imaging examination showed L 4, 5 foramen stenosis with far lateral disc herniation in 2 case, and L 5S 1 foramen stenosis with far lateral disc herniation in 15 cases, and the height of intervertebral space decreased, resulting in the compression of exiting nerve root and ganglion. Among them, far-out syndrome was diagnosed in 7 cases and transitional lumbarsacral vertebrae was found in 12 cases. The incisions were designed 2 cm away form the projection of adjacent pedicles, while incision at S 1 was designed at the inner edge of the iliac bone due to the shielding of the ilium, taking the outer edge of the isthmus at the outer opening of the intervertebral foramen as the target of channels. The ventral and apical part of superior articular process (SAP) was gradually removed with high-speed burr from its outer edge and isthmus, and the occluded sacral ala and the lower edge of transverse process were removed when necessary. The hyperplastic ligament was removed to expose the exiting nerve root. The protruding intervertebral disc was removed at the ventral side of the nerve root. The far-out syndrome was decompressed laterally along the exiting nerve root until it is completely released. The results and stability were evaluated with visual analogue scale (VAS), Oswestry disability index (ODI), Macnab scores and dynamic X-ray film during follow-up. Results:The operation time was 45-85 min, with an average of 60 min. After remove of the SAP tip and enlarge of the intervertebral foramen, the exiting nerve root and disc protrusion were fully exposed, the exiting nerve root was exposed and released laterally until totally release without entrapment in far out syndrome, and the nerve could be decompressed completely. The symptoms were significantly relieved after operation, and imaging examination showed that facet joints were preserved. During follow-up, the pain and function improved continuously. At final follow-up, the improve rate of VAS and ODI were 85.2% and 86.2%, respectively, and the results were excellent in 15 cases and good in 2 case according to Macnab score, and there was no lumbar instability on dynamic lumbar X-ray film.Conclusion:Extra canal lumbosacral nerve entrapment can be treated by UBE through extraforaminal approach, with sufficient exposure, complete decompression and better preservation of lumbar stability.
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Unilateral biportal endoscopic surgery, micro-endoscopic discectomy, micro-endoscopic laminoplasty, and Destandau mobile endoscopic discectomy have been described as four major techniques in the field of endoscopic spine surgeries. Compared with the coaxial endoscopy, the unilateral biportal endoscopic surgery is characterized by separated channels for observation and operation, making operative procedures more flexible, vision field wider, and requirements for surgical instruments less demanding. Although the anatomical basis of its surgical approach is similar to that of micro-endoscopic spine surgery, this technique can significantly reduce the injury to the paravertebral muscle and protect the stability of the surgical segment of the spine, leading to quick and wide applications in the clinical treatment of degenerative lumbar diseases with good clinical efficacy. The present article reviews this surgical technique from the aspects of technological development, anatomical basis, clinical application, complications, and prospects.
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Objective:To investigate the clinical efficacy of oblique intervertebral fusion in the treatment of failed internal fixation of thoracolumbar fractures.Methods:A retrospective study was conducted to analyze the clinical data of 14 patients who had undergone revision surgery for failed internal fixation of thoracolumbar fracture at Department of Orthopedics, The First Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. There were 6 men and 8 women with a mean age of 47.5 (42.0, 54.3) years. Fracture segments: T 12 in 2 cases, L 1 in 3 cases, L 2 in 4 cases, L 3 in 3 cases, and L 4 in 2 cases; AO classification: type A in 1 case, type B in 7 cases, and type C in 6 cases. Their prior surgical method was posterior internal fixation with pedicle screws. The revision surgery consisted of subtotal vertebral resection through the oblique lateral approach, bone column reconstruction and lateral screw-rod internal fixation for intervertebral fusion after posterior internal fixation reset. The operation time, intraoperative bleeding, postoperative hospital stay, and incidence of complications were recorded. Compared were visual analogue scale (VAS) and Oswestry disability index (ODI) scores for low back pain at preoperation, 3 days and 3 months postoperation, and the last follow-up, fusion at the last follow-up, and Frankel grading for neurological function at preoperation and postoperation. Results:All the 14 patients underwent surgery successfully and were followed up for 23 (18, 24) months. The operation time was (175.1±28.2) min, the intraoperative bleeding (300.4±122.6) mL, and the postoperative hospital stay 6 (6, 7) d. One case developed postoperative transient hip flexion weakness but was discharged after restoration of normal muscle strength by conservative treatment. Both VAS and ODI scores for low back pain at all postoperative time points were significantly improved compared with the preoperative values ( P<0.05), with a significant trend of 3 days postoperation >3 months postoperation > the last follow-up ( P<0.05). In the 12 patients with preoperative neurological damage, the Frankel grading rose by at least 1 level postoperatively ( Z=-3.110, P=0.002). The last follow-up revealed no loosening or fracture of the internal fixation. Complete bony fusion was visible in all CT sagittal reconstructions. Conclusion:For patients with thoracolumbar fracture undergoing failed internal fixation, oblique intervertebral fusion is an alternative minimally invasive surgical treatment due to its satisfactory overall outcomes.
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Objective:To compare the efficacy of robot-assisted and conventional fluoroscopy-guided percutaneous vertebroplasty (PVP) combined with pediculoplasty in treating symptomatic chronic thoracolumbar osteoporotic vertebral fracture (SCOVF) without neurological symptoms.Methods:A retrospective cohort study was used to analyze the clinical data of 120 patients with thoracolumbar SCOVF without neurological symptoms, who were admitted to Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2015 to January 2020. The patients included 34 males and 86 females, aged 63-85 years [(72.9±5.7)years]. All patients were treated with PVP combined with pediculoplasty. A total of 87 patients were treated with robot-assisted and C-arm X-ray machine guided puncture (robot group) and 33 patients with C-arm X-ray machine fluoroscopic-guided puncture (conventional group). The operation time, amount of bone cement injection and puncture accuracy were compared between the two groups. The results of vertebral body index, Cobb angle, visual analogue scale (VAS), and Oswestry disability index (ODI) were also compared before operation, at 1 day and 1 year after operation and at the final follow-up. Complications such as bone cement leakage and displacement were observed.Results:All patients were followed up for 24-36 months [(29.4±3.4)months]. The operation time was (85.2±10.5)minutes in the robot group, significantly longer than (37.2±3.7)minutes in the conventional group ( P<0.01). The amount of bone cement injection was (5.0±0.7)ml in the robot group, significantly less than (5.3±0.8)ml in the conventional group ( P<0.05). The puncture accuracy in the robot group was 95.4% (83/87), significantly higher than 81.8% (27/33) in the conventional group ( P<0.01). There were no significant differences in vertebral body index, Cobb angle, VAS or ODI between the two groups before operation (all P>0.05). The values of vertebral body index were 87.1±4.5, 86.9±4.3, 86.8±4.3 in the robot group at 1 day after operation, 1 year after operation and the final follow up, respectively, which were significantly higher than 83.6±4.4, 84.1±3.8, 84.4±3.9 in the conventional group (all P<0.01). There were no significant differences in Cobb angle or ODI between the two groups at 1 day after operation, 1 year after operation or the final follow-up (all P>0.05). The values of VAS were (2.9±1.0)points, (1.8±0.7)points, (1.8±0.7)points in the robot group at 1 day after operation, 1 year after operation and the final follow-up, respectively, which were significantly lower than (4.4±1.1)points, (3.1±0.8)points, (3.0±0.9)points in the conventional group (all P<0.01). The bone cement leakage occurred in 7 patients in the robot group [8.0%(7/87)] and in 10 in the conventional group [30.3%(10/33)] ( P<0.01). No delayed bone cement displacement [0.0%(0/87)] occurred in the robot group from 1 day after operation to the final follow-up, but 3 patients [9.1%(3/33)] were noted in the conventional group ( P<0.05). Conclusion:Both robot-assisted and conventional fluoroscopy-guided PVP combined with pediculoplasty have satisfactory effect for SCOVF patients without neurological impairment, but the robot-assisted one has the advantages of higher puncture accuracy, more satisfactory vertebral height recovery, more rapid pain relief, lower incidence of bone cement leakage and effective avoidance of cement displacement.
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Objective:To investigate the clinical efficacy of satellite rod revision surgery via a combined anterior and posterior approach for rod fracture after posterior vertebral column resection (PVCR) in patients with severe thoracolumbar kyphosis.Methods:A retrospective case series study was conducted on the clinical data of 11 patients with rod fracture after PVCR for severe thoracolumbar kyphosis, who were treated in Henan Provincial People′s Hospital from January 2013 to January 2021. There were 6 males and 5 females, with the age range of 21-62 years [(35.4±13.0)years]. Among them, 4 patients had traumatic kyphosis, 4 presented congenital kyphosis and 3 showed tuberculous kyphosis. All the patients had obvious low back pain. According to the American Spinal Injury Association (ASIA) score, 2 patients were found with grade C, 2 with grade D and 7 with grade E. All the patients underwent revision surgery for internal fixation using satellite rod via a combined anterior and posterior approach. The operation time, intraoperative blood loss and postoperative hospital stay were recorded. The imaging parameters such as kyphosis Cobb angle, scoliosis Cobb angle, distance between C 7 plumb line and central sacral vertical line (C 7-CSVL), and distance between C 7 plumb line and sagittal vertical axis (SVA) were measured preoperatively, at 1 week postoperatively and at latest follow-up. At the same time, the visual analogue scale (VAS), Oswestry dysfunction index (ODI), and simplified Chinese version of the scoliosis research society-22 (SRS-22) questionnaire were used to evaluate the clinical efficacy. At the latest follow-up, the osteotomy fusion was evaluated by Suk criterion and ASIA score was used to evaluate the recovery of neurological function. The complications were also recorded for the patients. Results:All the patients were followed up for 24-84 months [(47.5±16.2)months]. The operation time was 100-220 minutes [(149.4±37.6)minutes], with the intraoperative blood loss of 150-350 ml [(246.3±64.6)ml] and the postoperative hospital stay of 5-8 days [(6.1±1.1)days]. The kyphosis Cobb angles [(18.5±3.2)° and (19.3±2.9)°] and the scoliosis Cobb angles [(11.8±2.2)°, (11.1±2.2)°] at 1 week post-operation and at the latest follow-up were all improved significantly compared with the preoperative ones [(60.4±6.3)°, (21.7±5.5)°] (all P<0.01), with the average correction rates being 69.4% and 45.6%, respectively, with no significant differences between 1 week post-operation and latest follow-up (all P>0.05). The C 7-CSVL was reduced from preoperative (21.2±4.3)mm to (15.7±2.4)mm at 1 week post-operation, and to (15.9±2.2)mm at the latest follow-up (all P<0.01). The SVA was improved from preoperative (51.0±6.8)mm to (16.6±3.6)mm at 1 week post-operation, and to (15.3±3.9)mm at the latest follow-up (all P<0.01). There were no significant differences in C 7-CSVL or SVA at 1 week post-operation or at the latest follow-up (all P>0.05). The VAS [(2.5±0.9)points, (1.9±0.9)points], ODI (20.1±5.4, 18.4±5.2) and SRS-22 [(83.4±5.8)points, (85.0±4.1)points] at 1 week post-operation and at the latest follow-up were significantly improved compared with the preoperative ones [(6.0±1.4)points, 57.2±8.7, (62.0±9.1)points] (all P<0.01), but no significant differences were found between 1 week post-operation and latest follow-up (all P>0.05). At the latest follow-up, the bone grafts achieved osseous fusion in all the patients, and the ASIA grade was improved from grade C to grade D in 2 patients and from grade D to grade E in 2 patients. No complications such as serious neurological or vascular injury occurred during perioperative period. No pseudoarthrosis formation, internal fixation loosening or fracture occurred during follow-up. Conclusion:Satellite rod revision surgery via a combined anterior and posterior approach for rod fracture after PVCR in patients with severe thoracolumbar kyphosis has the advantages of less trauma and faster convalescence, excellent results of deformity correction, significant pain relief, functional improvement, and fewer complications.
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Objective:To compare the efficacies of posterior long segment instrumentation combined with transpedicular impaction bone grafting or with bone cement augmentation in treating stage III Kümmell disease.Methods:A retrospective cohort study was conducted to analyze the clinical data of 38 patients with stage III Kümmell disease who were admitted to Zhengzhou Orthopedic Hospital between January 2016 and December 2020. The study included 8 male and 30 female patients, with ages ranging from 59 to 81 years [(68.9±4.9)years]. The vertebral fractures occurred at T 8 in 1 patient, T 11 in 9 patients, T 12 in 10 patients, and L 2 in 10 patients. Seventeen patients underwent posterior long segment instrumentation combined with transpedicular impaction bone grafting (impaction bone grafting group), and 21 patients underwent posterior long segment instrumentation combined with bone cement augmentation (bone cement group). The surgical duration, intraoperative blood loss, and incidences of postoperative complications were compared between the two groups. Additionally, the visual analogue score (VAS), Japanese orthopedic association (JOA) score, and Cobb angle were compared before the operation, at 1 week and 3 months post-operation, and at the final follow-up for both groups. The study also compared bone healing at the last follow-up and postoperative complication rates between the two groups. Results:All the patients were followed up for 24-35 months [(28.7±2.9)months]. The impaction bone grafting group had a surgical duration of (150.7±25.4)minutes and intraoperative blood loss of (285.3±48.6)ml, significantly different from those in the bone cement group [(132.0±21.1)minutes, (251.4±44.8)ml] (all P<0.05). Before the operation, there were no significant differences in the VAS, JOA score, or Cobb angle between the two groups (all P>0.05).The VAS was (3.2±0.8)points, (2.7±0.5)points and (2.2±0.7)points in the impaction bone grafting group and was (2.7±0.6)points, (2.6±0.7)points and (2.4±0.8)points in the bone cement group at 1 week and 3 months post-operation and at the final follow-up, respectively. The VAS in the impaction bone grafting group was significantly higher than that in the bone cement group at 1 week post-operation ( P<0.05); however, no significant differences were found at 3 months post-operation or at the last follow-up (all P>0.05). There was no significant difference in the JOA score between the two groups at 1 week or 3 months post-operation, or at the final follow-up (all P>0.05). The Cobb angle in the impaction bone grafting group was (5.1±1.3)°, (5.9±1.8)° and (6.5±2.5)° at 1 week and 3 months post-operation, and at the final follow-up, significantly lower than that in the bone cement group [(8.4±1.6)°, (12.6±2.1)°, and (14.5±3.3)°] (all P<0.01). All the patients in the impaction bone grafting group achieved bone healing at the last follow-up. One patient in the impaction bone grafting group experienced delayed incision healing, whereas two patients in the bone cement group had poor bone healing. The complication rate was 5.9% (1/17) in the impaction bone grafting group and 9.5% (2/21) in the bone cement group ( P>0.05). Conclusions:Posterior long segment instrumentation combined with transpedicular impaction bone grafting or with bone cement augmentation are both effective in alleviating pain and improving the spinal function for stage III Kümmell disease. The former procedure is associated with longer surgical duration and increased intraoperative blood loss, but it can provide superior correction and maintenance of kyphosis deformity, promoting the healing of the injured vertebrae.
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Objective:To compare the effect of O-arm assisted and free-hand pedicle screw placement in the treatment of AO type C thoracolumbar fracture.Methods:A retrospective cohort study was used to analyze the clinical data of 34 patients with type C thoracolumbar fracture admitted to Henan Provincial People′s Hospital from January 2018 to June 2021, including 23 males and 11 females; aged 42-63 years [(50.4±7.4)years]. The fracture was located at T 11 in 4 patients, T 12 in 10, L 1 in 12, L 2 in 6, T 11~12/L 1 in 1 and T 12/L 1 in 1. Posterior reduction and internal fixation was carried out for all patients, of whom 18 were treated with O-arm assisted pedicle screw placement (navigation group) and 16 with free-hand pedicle screw placement (free-hand group). The operation time, single screw placement time, intraoperative bleeding volume, operation mode and screw placement accuracy were compared between the two groups. The kyphotic Cobb angle, visual analogue score (VAS) and American Spinal Injury Association (ASIA) score were compared between the two groups before operation, at 1 week after operation, at 3 months after operation and at the last follow-up. Postoperative complications were observed. Results:All patients were followed up for 12-29 months [(16.8±6.1)months]. There was no significant difference between the two groups in the operation time, intraoperative bleeding volume and operation mode (all P>0.05). The single screw placement time was (9.4±1.6)minutes in navigation group, but was (10.8±1.5)minutes in free-hand group ( P<0.05). The screw placement accuracy was 97.4% in navigation group, but was 81.5% in free-hand group ( P<0.01). The kyphotic Cobb angle and VAS had no significant differences between the two groups before operation (all P>0.05). The kyphotic Cobb angle in navigation group and free-hand group was (4.3±1.1)° and (5.9±1.1)° at 1 week after operation, (4.4±1.2)° and (5.7±1.3)° at 3 months after operation, and (4.4±1.2)° and (6.8±0.9)° at the last follow-up, decreased significantly from that before operation [(21.8±3.1)°, (22.2±3.2)°] (all P<0.01). The kyphotic Cobb angle in navigation group was significantly lower than that in free-hand group at 1 week, 3 months after operation and at the last follow-up (all P<0.01). The VAS in navigation group and free-hand group was (3.2±0.7)points and (4.1±0.7)points at 1 week after operation, (2.4±0.6)points and (3.0±0.8)points at 3 months after operation, and (1.8±0.9)points and (2.6±0.7)points at the last follow-up, decreased significantly from that before operation [(8.4±0.8)points, (8.3±0.9)points] (all P<0.01). The VAS in navigation group was significantly lower than that in free-hand group at 1 week, 3 months after operation and at the last follow-up (all P<0.01). The ASIA score showed no significant difference within and between the two groups before operation, at 1 week, 3 months after operation and at the last follow-up (all P>0.05). Postoperative incision infection occurred in 1 patient in both groups ( P>0.05). Implant failure such as loosening or displacement was not observed in navigation group, and only occurred in 2 patients in free-hand group ( P>0.05). Conclusion:Compared with free-hand pedicle screw placement, O-arm assisted pedicle screw placement in the treatment of AO type C thoracolumbar fracture has advantages of rapid and accurate screw placement, good reduction and notable pain relief.